Severe Constipation – Extreme Pain, Complications

Complications of Severe Constipation

Severe constipation, acute or chronic, has to be treated promptly, otherwise complications mentioned below, may develop.

1. Bloating

Bloating and severe pain, usually in the lower left abdomen may result from gas, produced by normal intestinal bacteria that break down fiber in the stool stuck in the colon. The left side of the abdomen is distended and usually tender to touch.

2. Lazy Colon

Lazy colon does not respond to presence of the stool in the colon and gastro-colic reflex that normally stimulate the bowel movement after food enters the stomach. Often even laxatives do not help. This poor colon activity may result from long term laxatives abuse, postponing bowel movements or prolonged bed rest. You often do not feel the urge to have a bowel movement. Lazy colon is a synonym for severe chronic constipation and does not mean a permanent colon impairment. You can achieve relief only by eliminating all possible causes of constipation and sticking with appropriate diet and active life style.

3. Fecal Impaction

In fecal impaction, a solid stool sticks in your colon and you can not expel it by your natural effort. It typically occurs in old bedridden patients, but can also affect other adults or children with chronic constipation or those taking opiates or methadone. A meal with a large amount of cereals without drinking enough fluid may also result in fecal impaction. In infants, rice cereals with milk could be the cause. Sensation of fullness or pain in the rectum, urge to defecate, abdominal discomfort, cramping, nausea and frequent urge to urinate are main symptoms. Clear stool may accidentally pass impacted stool; this is called paradoxical diarrhea. You may feel a hard lump when you press deeply upon the lower left part of your abdomen.

Sometimes you can remove the stool piece by piece using a finger, or a doctor can do so under local or general anesthesia. Forceful expelling hard stool is not recommended since your anus can tear. Water irrigation using a sigmoidoscope is sometimes necessary. Glycerin suppositories or phosphate or arachis oil enema may also be used. Stool softener, as docusate, may help pass the stool. If impaction is higher in the colon, an oral solution containing polyethylene glycol (as used in colonoscopypreparation) can be used carefully under doctor control. Rarely, operative removal of impacted stool is required.  Fiber laxatives, like metamucil, may be used as prevention of impaction (1). Read about foods that cause constipation.

4. Obstipation

Obstipation is severe constipation caused by intestinal obstruction, which may be acute or chronic, partial or complete. Constipation, abdominal distension, painful cramps and vomiting are main symptoms. Obstruction of the intestine may be caused by a polyp, cancer, scar tissue (adhesionsor strictures) developed after surgery or inflammation, volvulus (intestine twist upon itself – congenital defect found in infants), intussusception (telescoping, when one part of intestine slips into adjacent part; found in infants and young children), hernia, gallstones or foreign bodies. Certain diseases, like scleroderma, lupus or amyloidosis, can affect motility of the colonic wall. Ultrasound can detect excessive stool within the intestine. Obstipation has to be solved quickly by operation to prevent bowel perforation, bleeding or infection.

5. Rectal Prolapse

Rectal prolapse is protrusion of a part of the rectum through the anal opening during the bowel movement. It usually occurs in old people with chronic constipation who have week pelvic floor muscles and strain during the bowel movement. Full-thickness rectal prolapse usually causes constipation, while partial prolapse involving only the rectal lining does not.

Bulking laxatives or stool softeners may prevent aggravation of prolapse, but sometimes a surgery is necessary.

6. Rectocele

A rectocele, mostly occuring in women after menopause, means bulging of the rectum forward toward the vagina. It happens after heavy vaginal delivery or constant lifting of heavy loads. The stool may be trapped in the bulge. A doctor can detect this bulge during a vaginal and rectal examination.

Kegel exercises to strengthen muscles of pelvic floor may help in mild cases (2). If a rectocele protrudes through the vagina, surgery is usually necessary.

7. Anal Fissure

An anal fissure is a tear of the anal mucosa occuring during forced passage of large and hard stool. After the tear, you may feel severe pain lasting for several hours, and you may find blood on the stool or toilet tissue. Pain and bleeding during the bowel movements may persist for several weeks.

Treatment:

  • Warm sitz baths for 10-20 minutes few times a day sooth anal muscles
  • Stool softeners enable soft passage of the stool
  • Local analgesic creams relieve the pain
  • A tear usually heals completely in few weeks on its own, but sometimes surgical treatment is required.

Repeated injury of the anal sphincter by hard defecation may lead to patulous (widened, spreading) anus with diminished anal sphincter tone; a surgical repair is required in this case.

8. Chronic Hemorrhoids

Chronic hemorrhoids are common complication of chronic constipation. Treatment includes diet rich in fiber and fluid, physical activity, sitz baths, anti-hemorrhoidal and analgesic creams. Bluish hardened hemorrhoids with extreme anal pain and tenderness may result from thrombosed hemorrhoids, in which a blood clot form in the anal veins; an urgent surgical removal of a clot is required.

9. Non-Intestinal Complications

Urinary incontinence or infection or incomplete urine excretion are often connected with constipation where the rectum is full of hard stool.

Heavy straining may trigger heart attack or stroke. Holding breath and exerting raises the pressure in the chest cavity, preventing the blood from the veins to enter the heart. When the breath is released, the pressure within the chest drops and the blood having being trapped within the veins is quickly propelled through the heart, resulting in increased heart rate and blood pressure. Shortly thereafter, the heart rate reflexively slows down, what may trigger a heart attack in vulnerable persons. By the same mechanism, suddenly increased and then decreased blood flow in the brain may result in stroke or transient ischemic attack (TIA). Additionally, a blood clot may be dislodged from atherosclerotic brain arteries resulting in stroke. These are two causes of not so rare “toilet deaths” mostly occurring in old people with severe atherosclerosis. Squatting position during the bowel movement greatly reduces a need for straining.

References:

  1. Fecal impaction  (nlm.nih.gov)
  2. Kegel exercises  (mayoclinic.com)
About Jan Modric (249 Articles)
Health writer
  • Jan Modric

    Laura,

    I recommend you to ask the doctor openly, what exactly means that “your bowel is sitting on your bladder” and if a surgery would be needed. If even so strong laxatives, like senna don’t help, I’m not sure if you will be able to solve this with laxatives on long term.

  • frustrated

    I am extrememly frustrated. After reading all of these blogs and the answers…it appears as though the recommendations are repetitive and DO NOT HELP!!! Fiber, water, fruits, vegies…I’ve heard it all before and nothing works. And to top it off…doctors do NOT help either. So the only solution is HELP YOURSELF. Research the internet as if it were your doctor and maybe you’ll have some luck there. Good luck and many prayers to you all! Send some my way too!

  • DQ101

    Dear Jan,

    I have been suffering from severe constipation for the last 5 days. Did not have any bowl movement during these days. For the last couple of days, I’ve felt a hard stool which I just can’t pass however much I try. Now I have a continuous feeling that I want to go, but I cannot push anything out. Since I am an observant muslim, I know that the reason stems from the fasting during the month of Ramadan (I have only one meal a day). Can I take Laxatives to resolve this issue now, or it is too late since the stool is already hard and I cannot push it out?

    Many thanks for your help!

  • LMS818

    I am 22 years old. I have always had very regular bowel movements, usually at least one per day. However, I have only had two in the last five weeks. I do not take any medications, haven’t changed my diet at all, I exercise regularly, eat healthy, and drink a lot of water. I have tried laxatives, prune juice, etc ,and nothing works. My stomach looks puffy and I feel bloated and uncomfortable. Is there anything else I should try?

  • Jan Modric

    DQ101,

    you may try to break the hardened stool into small pieces with a gloved finger and excrete it part by part. Do not try to use any stick or any other object of any kind. To prevent further constipation, I strongly recommend you to include more fiber (especially soluble fiber – here’s a list of foods high in dietary fiber) and water in your meals – this will make your stools bulkier and softer and thus easier to excret. Also try to have bowel movements after meals, since the food that comes in the stomach triggers muscle contractions in the colon and thus helps in bowel movement.

  • Jan Modric

    LMS818,

    I can’t exclude intestinal bloackage – there could be polyps, intestinal worms – so I recommend you to see a doctor.

  • LMS818

    Thanks Jan. It all began when I ate out a restaurant and had a very upset stomach right afterward. Ever since then I have been constipated. I am feeling increasingly worse this week (bloated, general discomfort) and am seeing a doctor this Friday.

  • Jan Modric

    LMS818,

    seeing a doctor sounds as a good decision.

  • lindad

    pain on left side constantly,now spreading to the right,severe constipation,nothing helps,fibre,liquids,laxatives,feel like having my colon ripped out.

  • Jan Modric

    lindad,

    what is your diet, when did constipation start, do you take any drugs, do you have a sedentary life style, how old are you, male or female?

  • Ms. Smith

    I have not had a bowel movement in 4 weeks. What’s the risk and will colon hydrotherapy help me with this issue?

  • Jan Modric

    Mr. Smith,

    one possible risk is that the stool hardens and you won’t be able to excrete it with your own force. Or, some crack may occur during excretion. I recommend you to visit a doctor, who can give you exact instructions about what to do.

  • tamela

    i’ve jus recently given birth and i was fine with my bowels nothing i wasn’t used to and now this morning i woke up hardly able to breath feeling nauscious and every time i tried to push i felt like my insides were going to fall out of my vagina is that normal for constipation

  • Jan Modric

    tamela,

    if not caused by certain foods, low in fiber (chocolate, sweets, meat..) or foods that yield a lot of gas (oatmea, beans..), or certain medications, constipation could be from a partial blockage of the bowel due to intestinal parasites, for example or some organic cause..but hard to say from symptoms lasting one day. Gas may result in quite some pressure and nausea can appear in constipation, but still I can’t say is it a dietary or organic cause or food poisoning…

    I recommend you to avoid sugary foods, including fruits, and oats, legumes..and try whole grain bread, green vegetables, brown rice to prevent further constipation and bloating. Foods that may relieve constipation .

    If constipation worsens, visit a doctor.

  • MK

    Hello–My mom (76) developed severe constipation this summer, I think due to dehydration, not diet, as she is a semi-vegetarian. Ended up in the ER; her whole system was full. They did x-ray, CAT scan, gave her enemas & later we did Go-Lytely, which seemed to help clear things out. But a month later she is still not ok–we have her drinking water & juices, taking psyllium & probiotics, etc. She can only go now with a senna laxative, but when she does she doesn’t feel much better. She is miserable, cries a lot, has lost weight and seems to be fading away. I honestly am not sure she will survive this. Her doc seems unable to help & recommended just a colonoscopy–GI doc backed up almost *2* months. I am at my wits end… Any thoughts? Thanks so much.

  • Jan Modric

    MK,

    colonoscopy is not so bad idea. Colonic polyps of any type (including cancer), for example, can cause constipation and this can cause bloating. So, if this was recommended by a doctor, it should be doon as soon as possible.

    If she is not taking any antibiotics, probiotics are not likely of any use and can aggravate bloating. Psyllium husk, as other sources of soluble fiber makes stool softer, but can also produce a lot of gas.

    Intestinal parasites can also cause constipation and bloating. Diagnosis is with a stool test for parasites, treatment is with prescribed medications.

    If she feels week, some basic blood tests can reveal iron or vitamin deficiencies or other disorder.

  • kingmarki

    My wife suffers from severe constipation. She had a perforated bowel several years ago, leading to several surgeries, colostomy bag, final surgery to take down colostomy bag about 18 months ago. She regularly goes 10 to 14 days without movement. A 3 weeks ago she was hospitalized and had a colonoscopy during which they removed about 20 pollops. Since she left the hospital, she has only had 2 or 3 tiny bits pass. She is in severe pain, bloated and has tried everything they recommend. Stool softener, lactalose, more fiber, more water, exercise, etc. Dr.s are scratching their heads acting as if no one has ever had severe constipation before. She is 54, in decent health other than back her injury, ruptured discs. Any suggestions or anywhere we can go for help? We just retired to a little village in Maine and would love to enjoy our retirement and live long health & happy lives. Thank you for any help! Marki R.

  • Jan Modric

    kingmarki,

    it’s possible that polyps have contributed to constipation. Constipation after surgery is also common. Diverticulosis or some other cause of colonic call weakness is another possible cause (I suspect this because you’ve mentioned colonic rupture). Several polyps found means that other polyps may appear with time. Polyps at 54 are a strong risk factor for colonic cancer, but a surgeon can tell, if the exact type of polyps removed also represent a risk for cancer.

    The question is, if it is worth to have a colon that can rupture at any random time and in which cancer may develop. Colon can be completely removed and the end of the small intestine connected to anal canal without any considerable side effect for absorption of nutrients.

    Eventual pain from the ruptured disc can additionally aggravate constipation. Ruptured discs can be successfully treated by surgery.

    Even small amounts of certain foods, like chocolate or French fry can aggravate constipation. Oatmeal and other foods high in *soluble* fiber can help.
    Foods that may cause constipation http://www.healthhype.com/foods-that-cause-constipation.html
    Foods that may relieve constipation: http://www.healthhype.com/foods-that-cause-constipation.html

  • Scott

    I’m a 19 year old Male, and about weeks ago I had to use the bathroom, and when I went it hurt really bad, but I got it out. Then the next day I had to use it again, and it hurt really bad as well, but I eventually got it out. Ever since then I’ve been having problems making a Bowel Movement. I will have a urge to go, but when I go to the toilet the urge goes away, and nothing comes out, and when I do go, I have to strain really hard, and only a little comes out, and this has been going on for around a week now. I’ve also been experiencing some bad Chest pains, mainly on the left side of my upper chest, and I’ve been burping a bit, and just feel horrible. I’ve been really stressing out, and scared to death that I’m having a heart attack. I hurt really bad in my Stomach, and I’m bloated around my gut area, and can feel gas inside. These pains in my chest have been going on for about 3-4 days now. he Doc gave me some medicine for my Bowel Movment’s, and they seem to make me have an Urge to go, but it’s hard to get it out. I have to strain, but the stool isn’t hard. Anybody know what could be wrong with me? I’m really scared, and been stressing out alot. I’m on the verge of loosing my job becasue I’ve been so scared.

  • Jan Modric

    Scott,

    is bloating in the upper middle abdomen or in the lower abdomen?

    possible causes of burping, bloating and constipation include, stomach infection with bacterium Helicobacter pylori, intestinal parasites, fructose malabsorption, small intestinal bacterial overgrowth and other gastrointestinal conditions. A gastroenterologist should know which tests to make. Chest pain could be, among other, caused by gas in the bowel pressing upon the diaphragm.

  • Scott

    Jan, the Bloating is in my lower Abdomen.

  • Jan Modric

    Scott,

    I can’t give any helpful recommendation, but you can visit a gastroenterologist, who can make a stool test for parasites or whatever he/she will find necessary. It’s quite possible something is happening in your colon, blocking the stool to come out, causing gas and pushing upon the diaphragm resulting in chest pain. Colon cancer is rare before 40 years of age.

  • Pingback: What Causes Constipation? | Healthhype.com()

  • WorriedMOM

    My daughter is 21 years old. She has had chronic constipation since she was born. Her stool so hard and large it cannot be flushed down the toilet. She normally goes q2-3w weeks between bowel movements with the occasional movement producing a few very small round hard stools. (We call them rabbit droppings). Right now is gone 4 1/2 weeks with out a BM. She is very uncomfortable, very fatigued, bloated, no fever, no meds, high fiber diet, Active, graduating in the Spring so she has a normal stress of college but nothing crazy, has been investigated for Hirsprungs, which they say she doesnt have, and had a endoscope which showed “Megacolon?” and a barium enema which only showed that she had reflux causing an esphogeal web. That was when she was about 12. 3-6 weeks between BM’s seems very dangerous to me. I am afraid of her perforating her colon or ending up with a prolapse of some sort, or diverticulitis, fissures, etc. But, right now, I am just thinking that this could be very serious, as this is the longest she has gone without a BM.
    She is going to do a Magnesium Citrate tonite and try to cleanse herself. Another concern is that her 15 year old sister is exactly the same. Yet we have 6 children, 3 boys, 3 girls, and only 2 of the girls have this condition. I am very serious when I say that we cannot flush these down the toilet. They are the size of eggplants. Very heavy and very hard, as we have to get them out and dispose of them, so we know.
    I know she needs to get to a Gastro-guy, but is their any immediate concern with this 4 1/2 week lapse, in which I should take her to the ER? And, is there something else we should be telling the Gastroenterologist to get his attention? As she has been to a few and she also mentions it to her OB/GYN who blows it off and tells her to eat more fiber. Thanks!

  • Jan Modric

    WorriedMOM,

    going to ER could be a good idea, since they can flush her bowel safely without the risk of damaging the anus. In 4+ weeks the stool can become really large and can eventually cause the anal fissure. You’ve mentioned “megacolon”. Megacolon means distended colon with weakened wall from various causes, including hereditary ones (it’s possible your other daughter has the same condition). Megacolon can very well be the cause of constipation. The exact type of megacolon can be determined by a colonoscopy. The condition is managed with appropriate diet, and if this does not work, one possibility is a surgical removal of distended part of the colon (and to connect the healthy parts of the colon “end to end”, so without a colostomy).

    She should drink enough fluid to prevent dehydration, which may be a cause of fatigue. Eating more fiber helps to maintain soft stools, but after weeks of constipation, fiber may become contraproductive, since it may release a lot of gas. I recommend you to ask a gastroenterologist to make appropriate investigations to determine the exact cause of megacolon.

  • WorriedMOM

    Thanks. She did have a colonscopy a couple years back. It was negative. I am so confused.
    She did do the Magnesium Citrate yesterday, which produce one, very small, bowel movement, with bright red blood. She was pretty freaked out by the blood. I told her that bright red blood is not usually something to be worried about. I am making her an appt with the Gastro-guy tomorrow. Hopefully they can get her in soon. Does she need to go to the ER soon?

  • Jan Modric

    WorriedMOM,

    red blood in the stool may be from some “banal” cause, like ruptured hemorrhoid, but any blood in stool is considered as urgent condition, since you can’t really say where does the blood come from. Four weeks of constipation is enough of reason to get some help soon to prevent complications, like anal fissure and to find the cause of constipation. You can ask a gastroenterologist to go through her medical documentation and explain what exactly does “megacolon” you’ve mentioned mean.

  • jessica

    Since my c section 3 years ago I have been having bloating,constipation, hard pebble like stools(having to strain), vision problems(blurred/double vision). In the past year I have gained 75 pounds on a small 5-4 frame i am now 220 pounds, more then i weighed during my pregnancy. I typically weighed 130 and cannot seem to loss any weight, I have even went a few days without eating while taking fat burns and still put on weight. Any help would be greatly appreciated as I am a mom of a 3 year old and am having trouble breathing from the extra weight.

  • Jan Modric

    jessica,

    if you think you drink enough water and eat food with a sufficient amount of fiber and you don’t take any constipating drugs…than constipation and blurred vision could be explained by weak bowel and eye muscles. The original cause could be a neurological or hormonal problem, but your personal doctor could be more exact after examining you and ordering certain basic blood tests. You can check this personal medical history questionnaire to get prepared for an appointment.